PROSPECTIVE-STUDY OF THE NEED FOR LONG-TERM ANTISECRETORY THERAPY IN PATIENTS WITH ZOLLINGER-ELLISON SYNDROME FOLLOWING SUCCESSFUL CURATIVEGASTRINOMA RESECTION
Dc. Metz et al., PROSPECTIVE-STUDY OF THE NEED FOR LONG-TERM ANTISECRETORY THERAPY IN PATIENTS WITH ZOLLINGER-ELLISON SYNDROME FOLLOWING SUCCESSFUL CURATIVEGASTRINOMA RESECTION, Alimentary pharmacology & therapeutics, 7(3), 1993, pp. 247-257
A long-term cure is now possible in more than 30% of selected patients
with Zollinger-Ellison syndrome who undergo gastrinoma resection. The
need, however, for continued gastric acid antisecretory therapy in th
ese patients remains controversial. The current study was designed to
determine whether post-operative antisecretory therapy is needed in pa
tients who have undergone successful gastrinoma resection and, if so,
to attempt to define criteria with which to identify patients who requ
ire therapy. Twenty-eight consecutive patients who had previously unde
rgone curative gastrinoma resection were prospectively studied. When a
ntisecretory therapy was discontinued, 43% (12/28) of these patients d
eveloped gastro-oesophageal reflux, diarrhoea, acid-peptic symptoms or
endoscopic evidence of acid-peptic disease within 2 weeks and were de
emed to have failed a trial of antisecretory drug withdrawal. The rema
ining 57% (16/28) of patients who successfully discontinued antisecret
ory therapy were followed for a mean time of 31 months after withdrawa
l of therapy. Analysis of acid output studies pre-operatively, as well
as at the time of drug withdrawal, demonstrated that patients who wer
e unable to discontinue antisecretory therapy exhibited higher pre-ope
rative maximal acid output values and higher basal acid output values
at the time of attempted drug withdrawal than patients who were able t
o discontinue therapy. Despite these findings, there was significant o
verlap in acid output values between groups so that it was not possibl
e to define specific acid output criteria for successful drug withdraw
al. Pre-operative clinical characteristics, such as the presence or ab
sence of gastro-esophageal reflux or acid-peptic disease, or post-oper
ative laboratory values, such as the fasting serum gastrin level, did
not correlate with the ability to discontinue antisecretory therapy. W
e conclude that following successful curative gastrinoma resection, 40
% of patients still require antisecretory therapy and that both sympto
m evaluation as well as upper endoscopy should be used to guide attemp
ted drug withdrawal. Although patients who are not able to discontinue
therapy have significantly higher acid output measurements than those
who are able to discontinue therapy, neither acid output criteria nor
any other laboratory or clinical characteristics are able to predict
the need for continued antisecretory therapy in these patients.